MALAMULO MISSION HOSPITAL CLINICAL EDUCATION AND RESEARCH CENTER BY: BRANDON HODGE PROF. CHRIS HARNISH D10 MALAWI STUDIO SPRING 2019
PROBLEM STATEMENT How can the need of a Clinical Education and Research Center influence the behavior of both patients and medical staff to interact in a combination of interior and exterior spaces? The Malamulo Mission Hospital has been around for nearly one hundred years and continues to serve the rural communities that surround it. However, over the recent years it has been apparent that in order to keep the high quality of service and care to its patients it needs vital funding flows to begin at the heart of the campus. Most of the patients it serves are given free healthcare due to their poor economic status. For every paying patient that the hospital receives, that money helps fund the services of forty non-paying patients. This problem has prompted the immediate development of a Clinical Education and Research Center that will help spur medical knowledge and development as well as generate much needed government funding to support the hospital. However, one of the greatest predicaments in this decision is the transparency to which this future Clinical Research and Education Center will have. The client, Jason Blanchard CEO of Malamulo Mission Hospital, desires it to be a more private function that only medical staff have access to, but the culture of Malawi may say otherwise. The problem with this site and project is how to develop a research institution to meet the needs of the client while also maintaining a connection and interaction with the patients and public. How can the need of a Clinical Education and Research Center influence the behavior of both patients and medical staff to interact in a combination of interior and exterior spaces?
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TABLE OF CONTENTS Problem Statement 1 Thesis 3-4 Preliminary Research 5 - 16 Preliminary Analysis 17 - 28 Site Analysis 29 - 38 Design Intentions 39 -40 Design Constraints 41 - 47 Design Iterations 48 - 51 Final Design 52 - 69
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The Clinical Education and Research Center is viewed as a new addition that will increase the prominence of the Malamulo Mission
Hospital. This building will be the first of many that will be added to the existing campus; however, the hospital will need to know exactly what buildings to save and which ones to get rid of. Therefore, the first step of the entire CERC design process is to understand the campus and the culture of that campus. Through the early analysis it was apparent at how closely related each of the structures were. The close proximity was needed for medical staff and doctors to quickly reach another building in a rapid time in case of emergency. However, the programs of those buildings were placed in a very inefficient manner. The cafeteria, the main reason for the congestion within the brick archways, was at the center of the hospital campus. At lunchtime, students from the college would work their way to the cafeteria and cause congestion issues that prevented medical staff from navigating the corridors effectively. Another program issue was the entrance condition for public and private patients. There is limited parking at the site, and it is mostly saved for medical staff, but the patients that do arrive by car are forced to park at the front of the administration building. With the congestion of students and the public users, it prevents an efficient flow of circulation between user groups. The first step of the process was to create a series of masterplans that would reorganize the Malamulo Mission Hospital campus and find the most efficient place for the CERC building. The CERC building wanted to be placed in an area that would interact effectively with these various user groups, but also be separated enough to accommodate future expansion. Multiple variations and masterplans were developed to figure out the best place for the CERC building and where other future buildings might be located. From this exercise, four sites were located as potential locations for the CERC building, one behind the surgery ward, one was the community health building, one where the current classroom and lecture building resides, and one where the cafeteria exists. From the research and analysis of the site and the possible locations for future expansion, the site of the community health building made the most sense for the CERC building. The reason for the selection of this site was the flagship position the site held of the campus and the low interference to future expansion. The flagship position offered various challenges to solve. One challenge of the site was to navigate the twometer elevation change over the entire site. Though the elevation change seems minimal, it does create a massive impact of the foundations of any buildings that are built there. This problem most likely would be resolved by the staggering of foundations or the offsetting and building up of land to create earth-steps. Another problem of the site was how to incorporate the public patients and medical staff into the building. With the newly developed masterplan, a new public sector was developed along the front of the administration building, encouraging public circulation along the front of the campus. This suggests that the programming of the CERC building will incorporate uses for the public. The third problem of the site is the decision on how closely related or contextual the CERC should be to the rest of the campus. The idea that this is a flagship, prominent building having similar aesthetics of the rest of the campus might not be the correct decision. This process is what led up to the final overall design of the Clinical Education and Research Center.
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With this information, it led me to make various design decisions to make the most efficient CERC building for Malamulo Mission
Hospital. Through this process, multiple building designs were made to try and solve the various issues of the site. The first design was a two-building design with a shared courtyard between the two. This design worked for the separation of program that was desired by the client, but also allowed for the introduction of more public programming. However, the design did not integrate both programs together effectively resulting in two separate building designs. The second design shared the same courtyard design but acknowledged the surrounding context of the campus buildings more. This design still did not effectively integrate the two programs as they were still placed in separate buildings. This is the ending result that drove the final design. The final design used the shared courtyard, acknowledged the surrounding context in both material and shape, and integrated shared programming in both buildings. The site elevation change was acknowledged through a staggered floor plate design that dropped down a set dimension over a set distance. The layout works great for both private and public functions and gives people a new usable green space that previous did not exist at the campus. The following is the visual design process that created the final design for the Clinical Education and Research Center at Malamulo Mission Hospital.
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PRELIMINARY RESEARCH Preliminary research used to gain an understanding of the Malamulo Mission Hospital Campus and the culture of Malawi.
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MALAWI MALAMULO HOSPITAL
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GRASPING MALAMULO
OVERVIEW - WOMEN’S CLINIC
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GRASPING MALAMULO OVERVIEW - SURGERY
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GRASPING MALAMULO OVERVIEW - CLASSROOM
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GRASPING MALAMULO OVERVIEW - CAFETERIA
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GRASPING MALAMULO OVERVIEW - MATERNITY
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GRASPING MALAMULO
OVERVIEW - DEMOGRAPHICS
Size - Overall about 22 Acres (958,320 SF) - Main Site about 15 Acres (588,712 SF) Population - 250-275 Bed Capacity - Staff Numbers - 7 Full Time Doctors - “In summer Quarter hospital is at 120% - occupancy” Hospital Purpose - Private/Public Hospital - Renowned as a very reliable and safe hospital - Adventist Hospital Initial Findings - Understand all current research and information - Understand the hospital inventory - Looking at the Hospital like KCH - water/energy strategies - Site circulation
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GRASPING MALAMULO WHAT’S THE ISSUE?
Population Increase - The population of Malawi as a whole continues to grow and it is expected that within 20 years, the requirements for this hospital will double Lack of Resources - Much like KCH the hospital faces issues with - Water shortages in the dry season - Constant fear of water flow shutdowns - Lack of electrical power (non-reliable) Low Funding - Patients rarely pay for services - Patients that do pay are covering 40 non-payers - Funding mostly comes from foreign Adventist Donors
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GRASPING MALAMULO WHAT’S OUR ROLE?
Display hospital Growth - Develop Diagrams - Tell em’ (Hospital growth) - Population - Hospital building size - Hospital required resources - Tell em’ again (Hospital Program Option Assessment) - Site adaptation strategies - Expand site around current buildings (site phasing) - Create new hospital to the south east at road entrance - Tell em’ what you told em’ (Unique to each person) - CERC Design - new hospital layout - Framework plan - Complete design of CERC
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GRASPING MALAMULO OVERVIEW - LOCATION
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PRELIMINARY ANALYSIS Preliminary Analysis used to determine vital factors from the research used to influence the design.
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01.4
PROGRAM ADJACENCIES MALAMULO MISSION HOSPITAL
MMH has many different programs, of which all need to link together ina very specific way. There is also a sequence to patient flow that is illustrated below. This is important to understand because it helps when considering site layout, to know how patients move throughout the space. The second diagram illustrates program adjacencies. This is an extremely important aspect to all hospitals but is especially important at MMH. Due to the lack of resources and staff, the distance between programs that share requirements is of paramount importance.
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01.5
SITE GROWTH
MALAMULO MISSION HOSPITAL
MMH Growth over the next 20 years is displayed below. the graphics represent the size of the programs as they will grow over time. It is important to track this data not only from the size of the programs footprint, but also to understand that as the program grows, as does the amount of people needing to occupy that space. with this also come growth of staff requirements and resources.
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PROGRAM GROWTH
MALAMULO MISSION HOSPITAL
strategy must be developed.
5 YEAR EXPANSION
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10 YEAR EXPANSION
20 YEAR EXPANSION
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20 YEAR EXPANSION
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02.1
USER GROUPS CONFLICTS
MALAMULO MISSION HOSPITAL
STUDENTS INPATIENT DELIVERIES PUBLIC INPATIENT OUTPATIENT STAFF
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02.2
MANAGING ENTRY POINTS MALAMULO MISSION HOSPITAL
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02.3
PUBLIC VS PRIVATE
MALAMULO MISSION HOSPITAL
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02.4
MANAGING FINISHED FLOOR ELEVATIONS MALAMULO MISSION HOSPITAL
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SITE ANALYSIS Site Analysis used to determine the overall location of the CERC building and the affects it has on the Malamulo Campus.
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03.1
GROWTH OPPORTUNITIES MALAMULO MISSION HOSPITAL
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03.2
REPURPOSE VS. RELOCATION MALAMULO MISSION HOSPITAL
REPURPOSE RELOCATE
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03.3
CERC FLAGSHIP LOCATION OPTIONS MALAMULO MISSION HOSPITAL
OPT 1
OPT 3
OPT 2
OPT 4
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03.4
CRITICAL ADJACENCIES MALAMULO MISSION HOSPITAL
DELIVERIES
SERVICES WOMENS CLINIC
MATERNITY CAFE
PEDS
SURGERY
RAD/ ADMIN
PHARMACY
COM HEALTH
ENTRY
PRIVATE ANNEX
PRIV OUTPAT
INPATIENT
CLASS
LAB LECTURE
PRIMARY ADJACENCY SECONDARY ADJACENCY TERTIARY ADJACENCY
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03.5
PROGRAM LOCATIONS MALAMULO MISSION HOSPITAL
MATERNITY & PEDIATRICS
CENTRAL PROGRAMS
OPT 3
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ES
IC
V
R E S
C
M
R
P
E
EG
LL
O
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E T A IV
N I A
PU
B
C I L
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2m Elevation Change
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GREEN SPACE LOCATIONS 1. Forested area near the private inpatient ward 2. Small area located to the rear of the surgery ward 3. Small are located near the classroom.
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4. Possible location near the current community health building. Currently dead space due to angled archway
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5. Large open area to the northeast. However, is the location of septic systems and remains as a swamp-like field
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DESIGN INTENTIONS List of criteria placed in order to develop the most efficient design for Malamulo Mission Hospital.
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4 3
GROWTH
ADAPTABILITY
SUSTAINABILITY
CULTURE
- Identify different options for expansion over 20 years
- Utilize existing buildings to minimize the need for new construction
- Use green technology and methods to heighten user experience
- Maintain the hospital’s values of providing healthcare to the rural districts of Malawi
- Expand the hospital’s means to generate income for improvements - Provide for the influx of outside patients
- Integration of multiple users into a symbiotic environment
- Maximize natural building systems such as natural ventilation and lighting
- Use local building materials and building methods in architectural designs
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PROGRAM CONSTRAINTS The Malamulo Mission Hospital had a set area of constraints and challenges meant to target their needs for the CERC building. This influenced the overall design and process of development.
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04.1
HOSPITAL DESIRES
MALAMULO MISSION HOSPITAL
MMH is A meeting was held between Jefferson University and MMH on February 6th, 2019. Jason Blanchird, the CEO of MMH, informed the students of the hospitals growth, program locations, staff numbers and programs that needed to be added. The main topic of discussion was the Clinical Education and Research center. We discussed the program of the CERC as well as possible site locations.
The hospital has 250 permanent staff and 50 that are contracted staff. Not all of them work with patients, some are admin, grounds, and maintenance. These numbers will need to grow with the population of the hospital as well.
The hospital states that the wards that need to grow in the future: 1) Surgery 2) Pediatrics 3) Maternity Surgery ward is growing at a rate of 30%. Pediatrics is the largest ward at the hospital and is continuing to grow with the population.
The hospital states that the program pieces that can be replaced are: - Cafeteria - Classrooms - Lecture - Community Health These buildings are either in states of disrepair or a in locations where healthcare related programs would work better.
STAFF NUMBERS
NEEDS TO GROW
NEEDS TO GO
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There are certain program pieces that need to be added to the hospital. Those program pieces are: - Clinical Education and Research Center - Exterior waiting space - Surgery ward expansion
The CERC building has a few options on site where it can be located. It can be located adjacent to the surgery ward, replacing the community health building or replacing the classrooms and lecture building. There is also an option to replace the cafeteria with the CERC building.
The CERC building is intended to be a building that contains administrative services, outpatient care, surgical services and research services. All program elements are expansions upon current programs despite the research aspect. That aspect of the program is intended to further medical research as well as create a revenue stream within the hospital.
ADDED PROGRAM
S I T E OPTIONS
C E R C PROGRAM
01.1
CERC PROGRAM
MALAMULO MISSION HOSPITAL
CLINICAL TEACHING CENTER NEW CONSTRUCTION - ENTRY - LECTURE HALL - CONFERENCE/CLASS ROOM - SKILLS LAB - LIBRARY
PRIVATE OUTPATIENT CLINIC NEW CONSTRUCTION - RECEPTION/WAITING ROOM - BILLING AND ACCOUNTING OFFICE - VITAL SIGNS STATION / DRAW ROOM - EXAM ROOMS (4) - PROCEDURE ROOM (2) - POWDER ROOM
SIZE - 15 SQM - 150 - 200 SQM - 30 - 45 SQM - 50 - 100 SQM - 36 - 64 SQM TOTAL: 281 - 424 SQM
NOTES - SEATS 60 - 14 - 16 OCCUPANTS (TABLE SIZE) - SET UP LIKE OPERATING/CLINICAL - SOUND SENSITIVE
total program
SIZE - 15 - 25 SQM - 9 - 12 SQM - 9 - 12 SQM - 9 - 12 SQM (48 SQM) - 15 - 20 SQM (40 SQM) - 70 SQM TOTAL: 185 - 207 SQM
NOTES - ADJACENT TO EXIT - STARTING POINT OF PATIENT FLOW - PART OF PATIENT FLOW - MINOR PROCEDURES - TOILET SINK
total program
NOTES - GENERAL OFFICES - LARGER OFFICES - BULL PEN SETUP - KITCHENETTE, PRIVATE, SECURE SPACE
total program
DOCTOR/MEDICAL STAFF ADMINISTRATION NEW CONSTRUCTION - OFFICES - STANDARD (7) - OFFICES - SENIOR OFFICERS (3) - OPEN OFFICE - CALL ROOMS - STAFF LOUNGE
SIZE - 9 - 12 SQM (84 SQM) - 12 - 15 SQM (45 SQM) - 20 - 30 SQM - 12 - 16 SQM - 20 - 25 SQM TOTAL: 151 - 200 SQM
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TOTAL PROGRAM: 726 - 1,078 SQM ADVANCED SURGERY THEATER NEW CONSTRUCTION - ENTRANCE/WAITING - PRE OP ROOM - POST OP ROOM - SURGERY THEATER (4) - SANITATION ROOM - CHANGING ROOMS (2) - STAFF - CHANGING ROOM (2) - PATIENTS
GENERAL PROGRAMMING NEW CONSTRUCTION - PUBLIC RESTROOMS - STAFF RESTROOMS
SIZE - 15 SQM - 20 - 25 SQM - 20 - 25 SQM - 16 -20 SQM (80SQM) - 20 - 25 SQM - 5- 10 SQM (20 SQM) - 5- 10 SQM (20 SQM) TOTAL: 159 - 210 SQM
NOTES - AREA FOR FAMILY AND PATIENTS - 6 BEDS (MINOR PROCEDURES) - OPEN ROOM FOR 6 BEDS - INDIVIDUAL ROOMS - STERILE - STERILE ROOM FOR SANITIZING - SINK AND AREA FOR CLOTHES - SINK AND AREA FOR CLOTHES
SIZE - 64 - 120 SQM - 20 - 35 SQM TOTAL: 84 - 155 SQM
NOTES
total program
total program
EXTERIOR PROGRAMS NEW CONSTRUCTION - WAITING FOR PATIENTS/FAMILY - HEALING GARDEN - PRIVATE SPACE FOR STAFF
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SIZE - 20 - 30 SQM - 20 - 30 SQM - 20 - 30 SQM TOTAL: 60 - 120 SQM
NOTES - SPACE FOR PATIENTS - SEPERATE AREA ADJ TO LOUNGE
total program
and private inpatient ward to create a private section of the hospital. Nearby this set of program, a new radiology and lab building will be placed at the center of all the main hospital programs, creating easier access for medical staff. The surgery, maternity, and pediatric wards will all gain expansions to accommodate the influx of new patients. Near the road, a new public sector of the hospital will be created. This will continue to use the public inpatient building as well as reuse the old lab and lecture hall to become the new community health and public outpatient sectors. The existing parking lot will be expanded to accommodate the movement of public patients. A final aspect of the scheme is the movement of the classroom and the cafe over towards the University property, therefore reducing the number of students on hospital property and allowing the circulation paths to be clear
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DESIGN ITERATIONS List of criteria placed in order to develop the most efficient design for Malamulo Mission Hospital.
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CLINICAL EDUCATION BUILDING
ADMINISTRATION BUILDING
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ADMINISTRATION BUILDING
CLINICAL EDUCATION BUILDING
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FINAL DESIGN Proposed Final Design solution developed from the earlier research and development process.
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STAFF LOUNGE OPEN OFFICE SKILLS LAB
ADMIN OFFICES CALL ROOMS
CLASSROOMS SENIOR ADMIN OFFICES
LIBRARY
LECTURE HALL
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PROGRAM + SQ.FT. 1. LECTURE HALL - 1700 SF 2. LIBRARY - 100SF 3. CLASSROOM - 320 SF (2) 8 7
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4. SKILLS LAB - 1000 SF 12
5. STORAGE - 200 SF 6. OPEN OFFICE - 550 SF 7. RESTROOMS - 100 SF (2)
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8. ADMIN OFFICES - 140 SF (4)
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9. CONFERENCE ROOM - 400 SF 2
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10. STAFF LOUNGE - 450 SF 11. CALL ROOMS - 200 SF (3) 12. SENIOR ADMIN OFFICES 170 SF (3)
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REFLECTION After completing the Malawi studio and finishing a design for the Clinical Education and Research Center, I feel that there could have been so much more completed for this project. I did not stop designing this project until the very last possible moment. This allowed me to develop a stronger and better crafted idea and concept even though the drawings suffered in the end. Knowing that the idea is strong gives me more confidence to go back an edit the drawings I have completed. It is much harder trying to come up with an efficient idea, then beautiful drawings. If the idea does not exist, then the drawings do little to support the overall claim. Another piece of criticism I received was the consistency of drawings and views. Without the placement of the circle that exist on the Malamulo Campus, people were confused as to their orientation on the site. Including better contextual information and modeling, it would have strengthened the ideas even more. In terms of future research and direction of the project, I would like to do more research regarding materials and building strategies for Malawi. I did not get to design wall sections and detail sections in my presentation. The details and sections would have given me the ability to design for sustainable and culture purposes. I could have used local methods and materials in a similar way that MASS Design Group does. This overall would have strengthened the outcome of the design and design ideas.
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